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. 2024 Feb;52(1):129-137.
doi: 10.1007/s15010-023-02070-3. Epub 2023 Jul 9.

Pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH) in the German CAPNETZ-Cohort

Benjamin T Schleenvoigt #  1 , Juliane Ankert #  2 , Grit Barten-Neiner  3   4 , Florian Voit  5 , Norbert Suttorp  6   7 , Christoph Boesecke  8 , Christian Hoffmann  9   10 , Daiana Stolz  11 , Mathias W Pletz  2   3 , Gernot Rohde  3   12   13 , Martin Witzenrath  3   14 , Marcus Panning  4 , Andreas Essig  15 , Jan Rupp  3   16   17 , Olaf Degen #  18 , Christoph Stephan #  19 ; CAPNETZ Study Group
Collaborators, Affiliations

Pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH) in the German CAPNETZ-Cohort

Benjamin T Schleenvoigt et al. Infection. 2024 Feb.

Abstract

Objectives: The objective of this study was to identify the pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH), and to compare it with a matched HIV negative group in order to reassess therapeutic strategies for PLWH.

Methods: Seventy-three (n = 73) PLWH (median CD4 3-6 months before CAP: 515/µl; SD 309) with community acquired pneumonia (CAP) were matched with 218 HIV-negative CAP controls in a prospective study design. Pathogen identifications used blood culture, samples from the upper and lower respiratory tract (culture and multiplex PCR) and urinary pneumococcal and legionella antigen test.

Results: Although the vaccination rate among PLWH with CAP was significantly higher (pneumococcal vaccination: 27.4 vs. 8.3%, p < 0.001; influenza vaccination: 34.2 vs. 17.4%, p = 0.009), pneumococci were found most frequently as pathogen among both PLWH (n = 19/21.3%) and controls (n = 34/17.2%; p = 0.410), followed by Haemophilus influenzae (PLWH, n = 12/13.5%, vs. controls, n = 25 / 12.6%; p = 0.850). Staphylococcus aureus was found equally in 20.2 and 19.2% in PLWH and controls, but infection or colonization could not be distinguished. Mortality during 6-month follow-up was significantly higher for PLWH (5/73, or 6.8%) versus controls (3/218, or 1.4%), however with lower case numbers than previously reported. Typical HIV-associated pathogens such as Pneumocystis jirovecii were found only exceptionally.

Conclusions: Our study underscores the persistent clinical burden of CAP for PLWH. From pathogen perspective, empirical antibiotic treatment for CAP in PLWH on antiretroviral therapy should cover pneumococci and Haemophilus influenzae and may be adopted from valid common recommendations.

Keywords: CAP; Community acquired pneumonia; Empirical antibiotic treatment; HIV; PLWH; Pneumonia.

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Conflict of interest statement

Some of the authors have conflicts of interest. If the manuscript is accepted for publication by Infection, these will be specified in detail.

B.T. Schleenvoigt received fees and financial support from the Central German Working group HIV e. V., Gilead, MSD, Janssen-Cilag, Pfizer, CRM, Falk, AstraZeneca, ViiV, AIDS help Potsdam, AIDS help Dresden and Merck outside of the present work. G. Barten-Neiner received funding for CAPNETZ from German Lung Center (DZL) and Grants from Pfizer. F. Voit received fees and financial support from B. Braun Melsungen AG, MSD and Gilead outside of the present work. C. Boesecke received financial research grants from DZIF, NEAT ID, Hector foundation and honoraria from Abbvie, MSD, JnJ, Gilead and ViiV outside of the present work. M. W. Pletz received financial research support from Infectopharm and Pfizer and honoraria from MSD, Pfizer, Shionogi, Bayer, Sanofi, GSK, Thermofisher and Roche outside of the present work. M. Witzenrath received financial research support from DFG, Bundesministerium für Bildung und Forschung, Deutsche Gesellschaft für Pneumologie, European Respiratory Society, Marie Curie Foundation, Else Kröner Fresenius Stiftung, Capnetz Stiftung, Bayer Health Care, Biotest and honoraria from Astrazeneca, Insmed, Chiesi, Novartis, Teva, Actelion, Boehringer Ingelheim, GSK, Biotest, Bayer Health Care, Pantherna, Pherecydes, and Inflarx outside of the present work. C. Stephan received honoraria from Gilead, MSD, Janssen-Cilag, AbbVie, ViiV and TAD outside the present work. None competing interests for J. Ankert, N. Suttorp, C. Hoffmann, D. Stolz, G. Rohde, A. Essig, M. Panning, J. Rupp, O. Degen.

Figures

Fig. 1
Fig. 1
Median and individual values of CD4 (A) and viral load (B) 3–6 months before, during and 28 and 180 days after CAP. The mixed model was used to determine statistical significance. P-values refer in each case to the time during the CAP and are presented as follows: *p < 0.05, ***p < 0.001
Fig. 2
Fig. 2
Mortality of HIV-positive patients with CAP and matched HIV-negative controls over six months (Kaplan–Meier curve). Statistical differences between the groups were calculated using the log-rank (Mantel Cox) test. A higher mortality in the PLWH group could be shown (p = 0.013)
Fig. 3
Fig. 3
Distribution of pathogens for PLWH and control group. Total number of pathogens: PLWH n = 84, controls: n = 181. Statistical differences between groups were calculated using the Fisher exact test and Bonferroni correction. No significant differences were detected. The following pathogens were grouped together under "other": control group: Salmonella Serovar Enteritidis (n = 1), Streptococcus mitis (n = 1), Sputum culture: Arcanobacterium haemolyticum (n = 1). BAL culture: Prevotella melaninogenica (n = 1), Prevotella denticola (n = 1), Capnocytophaga spp. (n = 1)
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